Provider Demographics
NPI:1477649234
Name:CLARK, FRANCIS J (DPM)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:J
Last Name:CLARK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 W 9000 S
Mailing Address - Street 2:STE 301
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5710
Mailing Address - Country:US
Mailing Address - Phone:801-255-8633
Mailing Address - Fax:801-569-8335
Practice Address - Street 1:3584 W 9000 S
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5711
Practice Address - Country:US
Practice Address - Phone:801-255-8633
Practice Address - Fax:801-569-8335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT105275-0507213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT480035147OtherMEDICARE RAILROAD
UT4209390001Medicare NSC
UT480035147OtherMEDICARE RAILROAD
UTU000004373Medicare PIN